🔗 Share this article

Eight months pregnant and in severe pain, a woman named Stephanie visited the ER after an infection began spreading up her legs. Unemployed and homeless, cut off from her relatives, she stayed in a makeshift shelter she had constructed in a acquaintance's garden. She was also addicted to fentanyl.

As medical staff managed her infection, she started to feel anxious. Symptoms of withdrawal emerged. She leaned over the bed and vomited.

Stephanie ultimately gave in. “I need to leave. I have to go home and use drugs.”

She had consumed opioids before seeking medical help and had sufficient opportunity to get treated before she had to return to relapse. She thought she still had a month remaining to find a way to become sober and deliver her child.

The attending nurse disagreed. She told Stephanie she was not allowed to leave.

“Yes, I am,” Stephanie said.

But the hospital refused to discharge her: the leg infection was severe, but medical staff detected she also had an amniotic fluid leak. The nurse, a caregiver named Izzie, warned her: if she departed, she and her baby would not survive.

The nurse convinced the doctor to give Stephanie regulated amounts of fentanyl at regular intervals, knowing that symptoms could threaten her and the baby. After delivery Stephanie would be placed on methadone, a drug that alleviates cravings and is commonly used in addiction recovery.

Five days later, on the 12th of November, Stephanie gave birth to a daughter weighing 4lb 8oz – early, small but alive.

When the caregiver questioned if she wanted to hold her baby, Stephanie said “I cannot.” She was detached. Her pain relief did not work, her final administration of fentanyl had been provided four hours before delivery.

She felt ill. Not ready for motherhood. Undeserving.

Stephanie had sought recovery several times during pregnancy, and felt horrible each time she was unsuccessful. She felt hopeless, criticizing herself for not being able to achieve the unattainable. An doctor told her to “only” stop using. Even her dealer declined to supply to her when she became clearly expecting.

“But I couldn’t,” she said. “I required assistance.”

The pervasive expectation that her love for her baby would make her quit only led to deeper self-loathing and self-abuse, a trigger for her to use again. Yet she could not just wish her addiction away, any more than she could will away a chronic disease.

The newborn was transferred to the special care nursery. When Stephanie finally saw her her, she was connected to tubes and leads, so little she thought she would break her. Holding her for the first time, she felt nothing. “I gazed upon her and was like, ‘What is our future?’” She continued to doubt she wanted to be her mother.

After two days she decided to name her baby the same as her nurse, after the professional who provided support to her.

Hospital staff told her about a specialized facility, a unique recovery environment where parents and infants affected by substance use are supported as a unit, not apart.

In many parts of America, where a baby is diagnosed with newborn addiction symptoms regularly, infants are still rushed to special care and given drugs while their mothers face custody evaluations. But a developing system of centers like this facility is showing an important truth: when families are kept intact, outcomes improve, foster placements fall and long-term costs decline.

It took Stephanie some time to build confidence to call, but she ultimately reached out. After ensuring she qualified for the program, a couple of employees came to pick her up.

She left the medical center still in detox, fearful and unsure about what would follow.

---

At Maddie’s Place, Stephanie still worried that authorities would come seize her child – even though she was uncertain about motherhood. The fear lingered: that at any time, someone could arrive and remove her child.

For the first two weeks, Stephanie remained isolated. “I avoided interaction,” she said. “I lacked confidence at that point.”

Survival outdoors, she said, was about getting by. Substances came first; reliance came last.

Stephanie had a trusted ally, but even that relationship was delicate. The those close to her always found ways to cause pain. She was unable to care for herself, much less anyone else.

Every day, staff from the center drove her to a clinic for methadone, provided orally. Slowly, she was embracing sobriety.

She utilized each moment outside treatment with Izzie, and could see that her baby was obtaining necessary support she needed. Her infant faced feeding challenges at first, with sensitivity to certain foods and obvious stomach troubles. She needed dietary support. She also had heightened sensory issues and required an professional – all typical problems for babies affected by withdrawal.

When a child recognizes these infants need affection, then I was capable. I could parent.

On a day prior to the holiday, Stephanie was in the common room, where those still using can come for supervised visits with their babies. A support specialist, a peer support specialist, visited with her own children in tow to drop off cookies. They all assembled beside Stephanie, who was resting on the carpet holding Izzie.

The kids looked amazed in awe of the small baby in Stephanie’s arms. “They were innocent,” Stephanie said. “They didn’t care that I had used drugs with her. They focused only on the baby.”

She holds a picture of the moment. She is wearing casual attire, a cap with a decoration on her head, sitting on the wooden floor with the door behind her. She is thin. Her head is tilted forward so you cannot see her face. She is presenting her daughter on her knee for the children to see and they are standing close, admiring and touching to the baby.

Jacob, eight, asked the parents: “Where are all the dads?” The moms tried to explain that the fathers had obligations, engaged elsewhere, that they would be there if possible.

“Once I become a parent,” Jacob said, “I’m going to be the best dad ever. I will teach them about love.”

Stephanie and Bunch-Smith looked at each other. “I broke down,” Stephanie said. “When a child recognized that infants need affection, then I could do this. I could parent.”

---

Methods to address babies with exposure have been available for years.

The evaluation method was established in 1975|